CHN LEC (1) PDF

Health Care Delivery System 2. Shaping the research agenda and stimulating the  A health system, also sometimes referred to as generation, translation and dissemination of health care system, is the organization of valuable knowledge; people, institutions...

Health Care Delivery System 2. Shaping the research agenda and stimulating the  A health system, also sometimes referred to as generation, translation and dissemination of health care system, is the organization of valuable knowledge; people, institutions, and resources that deliver 3. Setting norms and standards and promoting and health care services to meet the health needs monitoring their implementation; of target populations. 4. Articulating ethical and evidence-based policy options; HEALTH SYSTEM ACCORDING TO WHO: 5. Providing technical support, catalysing change,  The health system consist of all organizations, and building sustainable institutional capacity; people and actions whose primary intent is to 6. Monitoring the health situation and addressing promote, restore or maintain health. This health trends includes efforts to influence determinants of health as well as more direct health-improving 1. To Eradicate Extreme Povert and Hunger activities. 2. To Achieve Universal Primary Education 3. To Promote Gender Equality and Empower Women WORLD HEALTH ORGANIZATION(WHO) 4. To Reduce Child Mortality  is a specialized agency of the United Nations 5. To Improve Maternal Health that is concerned with minternational public 6. To Combat HIV/AIDS, Malaria and Other health. It was established on 7 April 1948 Diseases 7. To Ensure Environmental Sustainability  With their headquarters at Geneva, 8. To Develop a Global Partnership for Switzerland Development There are 6 WHO regions, each with a regional office. In addition, WHO has 149 field offices in MILLENIUM DEVELOPMENT GOALS countries, territories or areas. Countries without a WHO office are covered by nearby field offices or The Millennium Development Goals (MDGs) were by the appropriate regional office international development goals for the year 2015 that had been established following the REGIONAL OFFICE Millennium Summit of the United Nations in  Africa September 6-8, 2000, following the adoption of  Americas the United Nations Millennium Declaration.  South-East Asia  Europe “To uphold these principles is their duty to all the  Eastern Mediterranean people of the world, especially the most vulnerable  Western Pacific and in particular, the children”  The objective of WHO is the attainment by all HEALTH RELATED MDG peoples of the highest possible level of Health GOAL 4: To reduce child mortality GOAL 5. To improve maternal health The organization’s Eleventh General Programme GOAL 6. To combat HIV/AIDS, malaria, and other of Work 2006-2015 details the six core functions it diseases is focusing on between 2006 and 2015. These functions are: GOAL 4: To reduce child mortality Target: 1. Providing leadership on matters critical to health Reduce by two-thirds, between 1990 and 2015, and engaging in partnerships where joint action is the under-five mortality rate needed; GOAL 5: To improve maternal health DOH: Targets: The Department of Health (DOH) is the principal - Reduce by three quarters, between 1990 and health agency in the Philippines. It is responsible 2015, the maternal mortality ratio for ensuring access to basic public health services -Achieve, by 2015, universal access to reproductive to all Filipinos through the provision of quality health health care and regulation of providers of health goods and services. GOAL 6: To combat HIV/AIDS, malaria, and other diseases Vision by 2030 Targets: A global leader for attaining better health - Have halted by 2015 and begun to reverse the outcomes, competitive and responsive health care spread of HIV/AIDS system, and equitable health financing. - Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it Mission - Have halted by 2015 and begun to reverse the To guarantee equitable, sustainable and quality incidence of malaria and other major diseases health for all Filipinos, especially the poor, and to lead the quest for excellence in health. SUSTAINABLE DEVELOPMENT GOALS MAJOR ROLES OF THE DEPARTMENT OF HEALTH The Sustainable Development Goals (SDGs) are a 1. LEADER IN HEALTH collection of 17 global goals set by the United 2. ENABLER AND CAPACITY BUILDER Nations General Assembly in 2015 for the year 3. ADMINISTRATOR OF SPECIFIC SERVICES 2030. CORE VALUES OF THE DOH 1. No Poverty INTEGRITY – The Department believes in upholding 2. Zero Hunger truth and pursuing honesty, accountability, and 3. Good Health and Well-being consistency in performing its functions. 4. Quality Education 5. Gender Equality EXCELLENCE – The DOH continuously strive for the 6. Clean Water and Sanitation best by fostering innovation, effectiveness and 7. Affordable and Clean Energy efficiency, pro-action, dynamism, and openness to 8. Decent Work and Economic Growth change. 9.Industry,Innovation,and Infrastructure 10. Reducing Inequality COMPASSION AND RESPECT FOR HUMAN 11. Sustainable Cities and Communities DIGNITY 12. Responsible Consumption and Production – Whilst DOH upholds the quality of life, respect 13. Climate Action for human dignity is encouraged by working with 14. Life Below Water sympathy and benevolence for the people in need. 15. Life On Land 16.Peace,Justice, and Strong Institutions COMMITMENT – With all our hearts and minds, 17. Partnerships for the Goals. the Department commits to achieve its vision for the health and development of future generations. SDG 3: "Ensure healthy lives and promote well- being for all at all ages." PROFESSIONALISM – The DOH performs its functions in accordance with the highest ethical standards, principles of accountability, and full responsibility. TEAMWORK – The DOH employees work together planning, implementation, monitoring and with a result-oriented mindset. evaluation, and surveillance using state-of the art technology and approaches. STEWARDSHIP OF THE HEALTH OF THE PEOPLE – REPUBLIC ACT 7160 otherwise known as the Local Being stewards of health for the people, the Government Code was enacted into law, Department shall pursue sustainable development transferring control and responsibility of delivering and care for the environment since it impinges on basic services to the hands of local government the health of the Filipinos. units (LGU). It aimed to enhance provision of services in the grass roots level as well as improve The following agencies are attached to the DOH: the efficiency in resource allocation. 1. Philippine Institute of Traditional and Alternative Health Care - Republic Act 8423 (R.A. UNIVERSAL HEALTHCARE ACT or RA 11223 was 8423) mandates the Philippine Institute of signed into law by President Duterte on February Traditional and Alternative Health Care 20, 2019 (PITAHC) “to improve the quality and delivery of health care services to the Filipino people through The act will automatically enroll Filipino citizens the development of traditional and alternative into the National Health Insurance Program and health care and its integration into the national expand PhilHealth coverage to include free medical health care delivery system“ consultations and laboratory tests. 2. Philippine Health Insurance Corporation (PHILHEALTH) - It was created in 1995 to WHAT MIGHT CITIZENS BE ABLE TO EXPECT? implement universal health coverage in the Philippines. It is a tax-exempt, 1. ALL FILIPINOS ARE COVERED government-owned and controlled corporation (GOCC) of the Philippines, and is attached to the Every single Filipino citizen is automatically Department of Health. Its stated goal is to "ensure enrolled into the a sustainable national health insurance program newly-created National Health Insurance Program for all", according to the company. (NHIP) 3. Philippine National AIDS Council The PNAC is a national advisory body which The program classified membership into two reviews and recommends policies on HIV/AIDS to types: the President and directs national approaches against HIV/AIDS domestically. DIRECT CONTRIBUTORS – those who pay PhilHealth premiums, are employed and bound by President Fidel Ramos signed Executive Order 39, an "employer-employee relationship," self-earning, creating the Philippine National AIDS Council professional practitioners, and migrant workers. (PNAC) on December 3, 1992, Members’ qualified dependents and lifetime members are also included. 4. Commission on Population The Commission on Population (POPCOM) is the INDIRECT CONTRIBUTORS – those not considered central policy making, planning, coordinating, and as direct contributors, along with their qualified monitoring body of the population program. dependents, whose health premiums are subsidized by the government. 5. National Nutrition Council Abbreviated as NNC, is an agency of the Philippine government under the Department of Health  All Filipinos will be granted “immediate responsible for creating a conducive policy eligibility” and access to the full spectrum of environment for national and local nutrition health care which includes preventive,  promotive, curative, rehabilitative, and 4. Essential health benefit package (primary care, palliative care. This can be expected for medicines, diagnostic, and laboratory tests. It also medical, dental, mental, and emergency health includes preventive, curative, and rehabilitative services. services) As long as a patient avails of these basic accommodations, it will be covered by PhilHealth  Filipinos will also be enrolled with a primary whether in a public or private hospital. health care provider of their choice. The primary care provider is the health worker HOSPITAL ALLOCATIONS: they can go and seek treatment from for GOVERNMENT HOSPITAL 90% health concerns. They will also serve as the SPECIALTY HOSPITAL 70% person in charge of referring and coordinating PRIVATE HOSPITAL 10% with other health centers if patients need further treatment. The law also states that if patients need to pay for extra expenses, their “CO-PAYMENT” or what is  Filipinos will also be enrolled with a primary paid on top of basic services – should be regulated health care provider of their choice. The by the DOH in public hospitals. primary care provider is the health worker they can go and seek treatment from for 3. PHILHEALTH WILL BECOME THE “NATIONAL health concerns. They will also serve as the PURCHASER” OF HEALTH GOODS AND SERVICES person in charge of referring and coordinating with other health centers if patients need This means that PhilHealth will be in charge of further treatment. paying health care providers like hospitals and clinics for services given to Filipinos.  Citizens will not need to present any PhilHealth ID to avail of these benefits. Meanwhile, poor Filipinos or those who are Funds for PhilHealth will be sourced from the located in geographically isolated areas will following: also be given priority when ensuring access to health services. 1. Philippine Amusement and Gaming Corporation – 50% of national government’s share 2. IT IS NOT COMPLETELY FREE. 2. Philippine Charity Sweepstakes Office (PCSO) – UHC does not mean every single health expense 40% of its charity fund, net of document stamp tax will be made free. The law outlines that basic payments, and mandatory PCSO contributions services accommodations will be covered by 3. Premium contributions of direct contributory PhilHealth members 1. Regular meals, 4. PhilHealth annual budget 2. Bed in a shared room with fan ventilation 3. Shared toilet and bath 4. DOH WILL STILL BE IN CHARGE OF 4. Essential health benefit package (primary care, “POPULATION-BASED” HEALTH SERVICES medicines, diagnostic, and laboratory tests. It also While PhilHealth, along with other private health includes preventive, curative, and rehabilitative insurance companies, is expected to cover services services) As long as a patient avails of these basic for individuals, the DOH is still in charge of accommodations, it will be covered by PhilHealth delivering health services that cover entire whether in a public or private hospital. populations. 1. Regular meals, 2. Bed in a shared room with fan ventilation 3. Shared toilet and bath 5. HEALTH SYSTEMS WILL BECOME CITY-WIDE BARANGAY HEALTH STATION AND PROVINCE-WIDE  On the other hand, a Barangay Health Station Provinces and highly urbanized cities will now be in (BHS) is the first contact health care facility charge of overseeing health services in areas as that offers basic services at the barangay level. opposed to the current set-up where municipalities are tasked with managing their own health centers  It is a satellite station of the RHU. 6. RETURN SERVICE IN THE PUBLIC HEALTH  It is manned by a volunteer Barangay Health SECTOR Worker (BHW) under the supervision of a Graduates of health and health-related courses Rural Health Midwife. who received government-funded scholarships will be required to work in the public health sector for THE RHU PERSONNEL at least 3 full years. This will address the need for health workers across the country. THE MUNICIPAL HEALTH OFFICER (MHO) He is also called as the Rural Health Physician who 7. A “HEALTH TECHNOLOGY AND ASSESSMENT heads the health services at the municipality level. COUNCIL” (HTAC) WILL BE CREATED Another important feature of the law is the FUNCTIONS OF THE MHO creation of the HTAC – a group of health experts 1. Administrator of the RHU who will be responsible for evaluating latest health a. Prepares the municipal health plan and budget developments and recommending their use to b. Monitors the implementation of basic health DOH and PhilHealth.The HTAC will be attached to services the DOH for the first 5 years after the law is c. Management of the RHU staff implemented. After this, it will become an independent body attached to the Department of 2 Community Physician Science and Technology. a. Conducts epidemiological studies b.Formulates health education campaigns on 8. HEALTH INFORMATION WILL BE COLLECTED disease prevention Both public and private hospitals and health c. Prepares and implements control measures or insurers will be required to maintain a health rehabilitation plans information system that will contain electronic health records, prescription logs, and 3.-Medico-legal officer of the municipality “human resource information.  Recommended ratio of Rural Health Physician to catchment population is 1 MHO: 20,000 population Implementing Rules and THE RURAL HEALTH UNIT Regulations (IRR) of RA 7305 or the Magna  It is commonly known as the Health Center. Carta of Public Health Workers  It is a primary level health facility in the THE PUBLIC HEALTH NURSE (PHN) municipality that focuses on preventive and promotive health services and the supervision FUNCTIONS OF THE PHN of Barangay Health Stations under its 1. Supervises and guides all Rural Health Midwives jurisdiction. (RHM) in the municipality. 2. Prepares the FHSIS quarterly and annual reports THE RURAL HEALTH UNIT of the municipality for submission to the Provincial Recommended ratio of RHU to catchment Health Office. population is 3. Utilizes the nursing process in responding to 1 RHU: 20,000 population (DOH, 2009) health care needs of IFC. 4. Collaborates with other members of the  They are trained in preventive health care with healthcare team, government agencies, private emphasis on maternal and child care, family businesses, NGOs and people organizations to planning and reproductive health, nutrition address the community’s health problems. and sanitation.  Recommended ratio of Public Health Nurse to  They are equipped with basic skills for catchment population is 1 PHN: 20,000 prevention and management of common population Implementing Rules and illness. Regulations (IRR) of RA 7305 or the Magna  They assist in providing basic services at the Carta of Public Health Workers BHS and RHU. THE RURAL HEALTH MIDWIFE (RHM) BARANGAY HEALTH WORKERS’ BENEFIT AND FUNCTIONS OF THE RHM INCENTIVE ACT (RA 7883) 1. Manages the BHS and supervises and trains  Entitles BHW to hazard and subsistence BHW. allowances and other benefits. 2. Provides midwifery services and executes health care programs and activities for women of  Recommended ratio of Barangay Health reproductive age, including family planning Worker to catchment population is 1 BHW: 20 counseling and service. households 3. Conducts patient assessment and diagnosis for referral or further management.  Implementing Rules and Regulations (IRR) of 4. Performs health information, education, and RA 7305 or the Magna Carta of Public Health communication activities. Workers 5. Organizes the community. 6. Facilitates barangay health planning and other RA 7160 LOCAL GOVERNMENT CODE community health services.  This law is enacted to bring about genuine and meaningful local autonomy.  Recommended ratio of Rural Health Midwife  This will enable LGU to attain their fullest to catchment population is 1 RHM: 5,000 development as self-reliant communities and population Implementing Rules and make them more effective partners Regulations (IRR) of RA 7305 or the Magna  in the attainment of national goals. Carta of Public Health Workers  It mandates the devolution of services, including health services. THE RURAL SANITATION INSPECTOR (RSI) DEVOLUTION  It refers to the act by which the national FUNCTIONS OF THE RSI government confers power and authority upon  Ensure a healthy environment in the the various LGU to perform specific functions municipality by advocating, monitoring and and responsibilities. regulating activities such as inspection of water supply and unhygienic household THE LOCAL HEALTH BOARD conditions.  The chairman is then local executive with the vice chairman in the person of the THE BARANGAY HEALTH WORKER (BHW) Provincial/City/Municipal Health Officer. Members of the board are composed of the  The barangay health workers are considered chairman of the committee on health of the as the interface between the community and Sanggunian, a representative from the private the RHU.  sector or NGO involved in health services and Legal basis: Letter of Instruction 949 signed by a representative from DOH. President Marcos on October 19, 1979 and has an underlying theme of “ Health in the Hands of the FUNCTIONS OF THE LHB People by 2020.” 1. Proposing to the Sanggunian annual budgetary allocations for the operation and maintenance of Mission: health facilities and services within the province, To strengthen the health care system by increasing city or municipality. opportunities and supporting the conditions 2. Serving as advisory committee to the wherein people will manage their own health care. Sanggunian on health matters. 3. Creating committees that shall advise local Concept: health agencies on various matters related to Partnership and empowerment of the people health service operation. towards the development of Self -Reliance THE HEALTH REFERRAL SYSTEMREFERRAL Elements/ Components of PHC It is a set of activities undertaken by a healthcare ✓ Education for Health facility in response to its inability to provide the ✓ Locally endemic diseases control necessary health interventions to satisfy a patient’s ✓ EPI need.TYPES OF REFERRAL ✓ Maternal & Child Health & Family Planning. ✓ Mental Health 1. INTERNAL REFERRAL ✓ Essential Drugs Occurs within the health facility. It is made to ✓ Nutrition request for an opinion or suggestion, ✓ Treatment of CD and NCD comanagement, or further management of ✓ Safe water/ Environmental sanitation specialty care. KEY PRINCIPLES OF PHC 2. EXTERNAL ✓Accessibility, Availability, Affordability & It is a movement of a patient from one health Acceptability of health services facility to another. It may be vertical or horizon ✓Community Participation ✓People are the center, object and subject of development PRIMARY HEALTH CARE ✓Self-reliance ✓Partnership between the community and the World Health Organization (WHO) defines PHC as health agencies in the an essential care made universally accessible to provision of quality of life. individuals and families in the community by ✓Recognition of interrelationship between the means acceptable to them through their full health and development participation and at a cost that the community and ✓Social Mobilization country can afford at every stage of development. ✓Decentralization Background FOUR CORNERSTONES/ PILLARS IN PHC: Primary Health Care (PHC) was declared during the 1. Community Participation First InternationalConference on Primary Health 2. Inter- sectoral coordination Care held in Alma Ata, Russia on September 6-12, 3. Appropriate Technology 1978 by the World Health Organization (WHO). The 4. Support mechanism made available goal was “ Health for All by the Year 2000 ”. This was adopted in the Philippines through  Types of PHC Workers Infirmaries, municipal, district hospital, out- patient departments. 1. Grassroots/ Village or Barangay Rendered by specialists in health facilities. Health Workers (V/BHWs)- refers to trained community health workers of health auxiliary 3. Tertiary Level of Care volunteer or a traditional birth attendant or healer. Referral system for the secondary care facilities. Provided complicated cases and intensive care. 2. Intermediate level health workers- general Medical centers, regional and provincial hospitals, medicine practitioners or their assistants. PHN, and specialized hospitals. Rural Sanitary Inspectors and Midwives may compose these groups. Levels of Health Care Services Levels of Prevention 1. Primary Prevention- relates to activities directed 1. Primary Level Facilities at preventing a problem before it occurs by -Health services offered to individuals with fair altering susceptibility or reducing exposure for health & to clients with diseases in early susceptible individuals. symptomatic stages. Include RHU, Community Examples: Quit smoking, avoid/ limit alcohol intake, Hospitals, Health Centers, Private Practitioners, exercise regularly, complete immunization Puericulture Center, Brgy. Health Stations. 2. Secondary Prevention- refers to early detection and prompt intervention during the period of early 2. Secondary Level Facilities disease pathogenesis. - Offer services to clients with symptomatic stages Examples: annual PE, regular Pap’s test for women, of disease which require moderately specialized sputum examination for TB. knowledge & technical resources for adequate treatment. Include emergency/ district hospitals, 3. Tertiary Prevention- targets populations that Provincial/ City Health services & facilities have experienced disease or injury and focuses on limitation of 3. Tertiary Level Facilities: disability and rehabilitation. -Include highly technological and sophisticated Example: self- monitoring of blood glucose among services offered by medical centers and large diabetics, physical therapy after CVA (stroke), hospital. These are specialized hospitals/ undergoing speech therapy after laryngectomy. institution. National & regional Health Services, Medical Centers, Teaching & Training Hospitals Levels of Healthcare and Referral System  National &Regional Health Services/ Medical Centers/ Training Hospitals 1. Primary Level of Care  Provincial/ City Health Services & Hospitals/ Devolved to cities and municipalities District/ Emergency Hospitals Usually the first contact between the community  Rural Health Units/ Barangay Health Stations/ members and other levels of the health facility. Community Hospitals and Health Centers/ Center physicians, public healthnurses, rural Private Practitioners/ Puericulture Centers health midwives, traditional healers. 2. Secondary Level of Care Given by physicians with basic health training. Usually given in health facilities either privately owned or government operated.  COMMUNITY HEALTH NURSING ✓CHN integrated health education and counseling as vital parts of functions. Is a service rendered by professional ✓Collaborative work relationships with the co- nurse with the Community, Groups, workers and members of the health team facilities Families, and Individuals at home, in accomplishments of goals. health centers, clinics, schools, place of work for the promotion of health, ✓Periodic and continuing evaluation provides the prevention of illness, care of the sick means for assessing the degree to which CHN goals at home and rehabilitation. and objectives are being attained. OBJECTIVES: ✓Continuing staff education program quality ✓ To participate in the development of an over all services to client and are essential to upgrade and health plan for the community. maintain sound nursing practices in their setting. ✓To provide quality nursing services to individuals, families & communities. ✓ Utilization of indigenous and existing ✓To coordinate nursing services with various community resources maximizing the success of members of health team. the efforts of the Community Health Nurses. ✓To participate in and/or conduct researches relevant to community health and community ✓Active participation of the individual, family and health nursing services and disseminate their community in planning and making decisions for results for improvement of health. their health care needs, determine, to a large extent, the success of the CHN programs. *Philosophy: Worth and dignity of man ✓Supervision of nursing services by qualified by CHN personnel provides guidance and direction to *Ultimate Goal: the work to be done. To raise the level of health of the citizenry. ✓Accurate recording and reporting serve as the basis for evaluation of the progress of planned *Primary focus: Health promotion programs and activities and as a guide for the and disease prevention future actions. *Primary Goal: Self-reliance in *MISSION OF COMMUNITY HEALTH Health NURSING PRINCIPLES: ✓Health Promotion – actions related to lifestyles ✓Is based on recognized needs of communities, and choices that maintains / families, groups and individuals. enhances a population’s health. ✓Health Protection – includes activities designed ✓Knowledge and understanding of the objectives to detect or prevent illness or alter disease and policies of the agency facilities goal processes. achievement. *Health Balance – state of well being that results ✓CHN considers the family as the unit of service. from a healthy interaction between a person’s body, mind, spirit and environment. ✓Respect for the values, customs and beliefs * Disease Prevention – activities designed to protect people from disease and its consequence *Social Justice – all people have a right to certain DETERMINANTS OF HEALTH AND DISEASE “basics” of life and health protection. Health- WHO defines health as “a state of *CLIENTS OF THE NURSE complete physical, mental and social well-being ✓INDIVIDUAL (sick or well) Can be considered as and not merely the absence of disease or infirmity. entry point in working with the whole family. Illness- Highly personal state in which the person’s ✓FAMILY physical, emotional, intellectual, social, Health task: developmental or ❑ Recognizing interruptions of health or spiritual functioning is thought to be diminished. Development ❑Seeking health care Diseases- alteration in body functions resulting in ❑ Managing health & non health crises reduction of capacities or a shortening of normal ❑ Providing care to the sick, disabled & dependent life span. member of the family ❑ Maintaining a home environment conducive to Determinants of Health good health & development The range of personal, social, economic and ❑ Maintaining good relationship with environmental factors that influence health status. community & health institution. Factors that make a person healthy or not. ✓POPULATION GROUP A group of people who share common Political factors characteristics, developmental stage or common ❖ refers to one’s leadership, how he rules, exposure to particular environmental factors & manages and how other people concerned are consequently common health problems:(Children, followed to actively participate in the decision Elderly) making process. ✓COMMUNITY Keywords: Group of people sharing common geographic o Social Justice boundaries, values & interests. o Human rights o Equity *The hallmark of community health nursing is that o Decision- making it is population- or aggregate-focused o Leadership & Governance Economic factors ❖ Production, distribution and consumption of goods and services and how these affect health and development. Keywords: o Health and development( relationship) Higher income and social status are linked to better health. Elevated death rates for the poor. Inequitable distribution of income and wealth may itself cause poor health. Socio-cultural factors Social Support Networks ❖ Influence a client’s health practices, dynamics of health care and the client-care provider Greater support from families, friends and relationship. communities are linked to better health. Those who have weak support system are more Keywords: prone to mental illness, substance abuse and o Culture depression. o Beliefs o Traditions  Double burden of disease Example: Jehovah’s witnesses, Iglesia Ni Cristo,  Triple burden of disease Biological/ Genetics ❖ Permanent and cannot be altered. Personal Behavior and Coping Skills ❖ Based on the genes of the parents. To be healthy, a person must: Ex: Balanced eating ✓ Hypertension Active lifestyle ✓ Diabetes Mellitus Do not smoke and drink ✓ Cancer Successfully deal with life stresses and challenges EDUCATION Examples: Personal habits- smoking, ❖ Low education levels are linked with poor Lifestyle- obesity ( Americans because of their diets) health, more stress and lower self-confidence. Example: Women who are educated are more Health Services likely to seek medical consultation during ❖ Access and use of services that prevent and pregnancy. ( nutrition for the family, immunization) treat disease influence health. Ex: Presence of Barangay Health Station per barangay. Physical Environment For an individual to be healthy, there should be: Services must be: Safe water ✓ Accessible Clean Air ✓ Affordable Healthy workplaces ✓ Available Safe houses, communities and roads ✓ Appropriate Gender Deviation in health may follow if: ❖ Men and women suffer from different types of Hazardous waste/ Toxic chemicals diseases at different ages. Noise ❖ Life expectancy: Residential Crowding (Ex: Tuberculosis, diarrhea- Male- 67, female-72 causing virus & bacteria, fungal and skin diseases) Ex: More men suffer from CVD than women. Employment and working conditions ❖ People in employment are healthier particularly those who have more control over their working conditions. Example: Hot tempered or impatient supervisor may affect his/ her subordinates. ✓ Learn to see the good side. Think positive.  PUBLIC HEALTH NURSING During the visit the PHN identifies together with the supervise any issue or problem encountered What is Public Health? and addresses them accordingly. According to Dr. C.E. Winslow, he defines public health as the “science and art of preventing 03 Nursing Function disease, prolonging life, promoting health and An inherent function of the nurse efficiency.” Her practice as a nurse is based on the science and art of caring GOAL: To enable every citizen to realize his Public health nursing is caring for individuals, birthright of health and longevity. families and communities toward health promotion and disease prevention Achieved through community effort PHN are expected to provide nursing care PHN uses her knowledge and skill in the nursing What is Public Health Nursing? process. She does assessment, plans, and According to WHO Expert Committee of Nursing, implements care, and evaluates outcomes. PHN is a “special field of nursing that combines the Establishes rapport with her client: individual, skills of nursing public health and some phases of family or community social assistance and functions as part of the total Home visits public health program for the promotion of health, Referral of patients to appropriate levels of care the improvement of the conditions in the social and physical environment, rehabilitation of illness 04 Collaborating and Coordinating Function and disability.” Brings activities or group activities systematically into proper relation or harmony with each other. STANDARDS OF PUBLIC HEALTH NURSING Care coordinators for communities and their members IN THE PHILIPPINES Actively involved both socially and politically to empower individuals, families and communities as Public Health Nurses must be/have: an entity to initiate and maintain health promoting 1. BSN Graduate environments. 2. Registered Nurse 3. Member of PNA 05 Health Promotion and Education Function 4. Good moral Character Activities goes beyond health teachings and health information campaigns. 01 Management Function Understanding the multidimensional nature of The management function of the public health health will enable her to plan and implement nurse is inherent in her practice. health promoting This function is performed when she organizes interventions for individuals and communities. the “nursing service” of the local health agency Uses her skills in advocacy for the creating of a A program manager supportive environment through policies and re- engineering of the physical environment for 02 Supervisory Function healthier actions. PHN is the supervisor of the midwives and other auxillary health workers in the catchment area. Formulates a supervisory plan and conducts supervisory visits to implement plan. Conducts supervisory visits using a supervisory checklist 06 Training Function 2. Prepare the family record of new patients or Initiates the formulation of staff development retrieve records of old clients. and training programs for midwives and other 3. Elicit and record the client’s chief complaint and auxiliary workers clinical history. Does training needs assessment for these health 4. Perform physical examination on the client and workers, designs the training program and record it accordingly conducts them in collaboration with other resource persons. II. Waiting time Also does evaluation of training. 1. Give priority numbers to clients. PHN participates in the training of nursing and 2. Implement the “first come, first serve” policy midwifery affiliates in coordination with the faculty except for emergency/ urgent cases. of colleges of nursing and midwifery. III. Triaging 07 Research Function 1. Manage program- based cases. Participates in the conduct of research and 2. Refer all non- program based cases to the utilizes research findings. physician. PHN function is disease surveillance. Purposes of 3. Provide first- aid treatment to emergency cases disease surveillance: and refer when necessary to the next level care. - To measure the magnitude of the problem - To measure the effect of the control program IV. Clinical Evaluation 1. Validate clinical history and physical examination It is important in monitoring the progress of the 2. The nurse arrives at evidence- based diagnosis disease reduction initiatives: Poliomyelitis, and provides rational treatment based on DOH Neonatal Tetanus Elimination, Measles Control, programs. NCD risk factors, etc a. Identify the patient’s problem b. formulate/ write the nursing diagnosis and validate TYPES OF PUBLIC HEALTH NURSING c. give/ perform the nursing intervention d. evaluate the intervention if it has enabled the CLINIC VISIT patient to It is a process of checking the client’s health achieve this desired outcome condition in a medical clinic. 3. Inform the client on the nature of the illness, the The patient visits the health center/ clinic to appropriate treatment and prevention and control avail of the services thereto offered by the facility measures. primarily for consultation on matters that ailed them physically. V. Laboratory and other diagnostic examinations Pre-consultation conference- A pre-clinic lecture 1. Identify a designated referral laboratory when is usually conducted prior to the admission of needed. patients, which is one way of providing health education. VI. Referral System 1. Refer the patient if he needs further Standard Procedures Performed during Clinic management following the two- way referral Visits system (BHS to RHU, RHU to RHU, RHU to Hospital). I. Registration/ Admission 2. Accompany the patient when an emergency 1. Greet the client upon entry and established referral is needed. rapport. VII. Prescription/ Dispensing GUIDELINES TO CONSIDER REGARDING THE FREQUENCY OF HOME VISITS VII. Health Education HOME VISIT Is a family- nurse contact which allow the health 1. The physical needs, psychological needs and worker to assess the home and family situations in educational needs of the individual and family. order to provide the necessary nursing care and health 2. The acceptance of the family for the services to related activities. be rendered, their interest and the willingness to cooperate. PURPOSE OF HOME VISIT 1. To give nursing care to the sick, to a post-partum 2. The policy of a specific agency and the emphasis mother and her newborn with the view to teach a given towards their health programs. responsible family member to give the subsequent care. 3. Take into account other health agencies and the number of health personnel already involved in the 2. To assess the living condition of the patient and care of a specific family. his family and their health practices in order to provide the appropriate health teaching. 4. Careful evaluation of past services given to a family and how the family avail of the nursing 3. To give health teachings regarding the services. prevention and control diseases. 5. The ability of the patient and his family to 4. To establish close relationship between the recognize their own needs, their knowledge of health agencies and the public for the promotion available resources and their ability to make use of of health their resources for their benefits. 5. To make use of the inter- referral system and to promote the utilization of community services. STEPS IN CONDUCTING HOME VISITS 1. Greet the patient and introduce yourself PRINCIPLES INVOLVED IN PREPARING FOR 2. State the purpose of the visit A HOME VISIT 3. Observe the patient and determine the health needs 1. A home visit must have a purpose or objective. 4. Put the bag in a convenient place then proceed 2. Planning for a home visit should make use of all to perform the bag technique available information about the patient and his 5. Perform the nursing care needed and give health family through family records. teachings 3. In planning for a visit, we should consider and 6. Record all important data, observation and care give priority to the essential needs of the individual rendered and his family. 7. Make appointment for a return visit. 4. Planning and delivery of care should involve the individual and family. 5. The plan should be flexible.  EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES 1982 – E.O 851 reorganized the DOH to synchronize health structures and operations with PHN SPANISH REGIME - Bro. Juan Clemente the shift to parliamentary form of government started health services through a dispensary in whence it became known as the Ministry of Health Intramuros. Start of water sanitation Introduction (later, under the of small pox vaccine. presidential form, as Department of Health). AMERICAN REGIME 1898 - Creation of the Board Significant Changed: of Health for Physicians Branching out of the office of Public health services to form the office of special concern. 1901 - Creation of Board of Health for City of Manila, Provincial and Municipal Boards of Health National Immunization Day 1905 – abolished Board of Health, activities were National Micronutrient Campaign (Araw ng taken over by the bureau of health under Sangkap Pinoy) Department of Interior Disaster Management Urban Health and 1906 – abolition of Board of Health; creation of Nutrition Project Bureau of Health Traditional Medicine Doctors to the Barrios 1912 – Creation of Sanitary Divisions Program Let’s DOH it! became a national battle cry. 1996 – Primary Health Care as strategy to attain 1915 – BOH was renamed Philippine Health Health for All by the year 2000 Service with Director of Health as head. 1999 – Creation of the National Health Planning 1928 – First convention of Nurses was held Committee (NHPC) And establishment of Inter-Local Health Zone 1999 1930 – Section of PHN was converted to Section 2004- Health Sector Reform Agenda of the of Nursing Philippines was launched 1933 – Reorganization act 4007 – Division of 2005 – DOH launched Fourmula One for Health Maternal & Child Health of the office of Public to ensure speed, precision and effective welfare commission coordination towards improving the efficiency, was transferred to Bureau Of Health effectiveness and equity of Health Care deliver ERA OF THE REPUBLIC OF THE PHILIPPINES (1946 to present) 1947 – Bureau of Public welfare was renamed DOH June 1957 – Rep Act 1891 (An act Strengthening Health and dental Services in the Rural Areas). 1975 – Formulation of the National Health Plan and the restructured Health Care delivery system ROLES AND FUNCTIONS OF A COMMUNITY administrator of a unit or program of the health HEALTH NURSE agency 10. Researcher - Planning and conduct of nursing WHAT IS ROLE? and related studies that contribute to the - It refers to a set of behavior patterns improvement of that are deemed appropriate for and nursing and health related services. expected of a person by virtue of his status in society and/or a position he 11. Role Model - The nurse is called upon to occupies in an organization. provide a good example of healthful living to the community, to practice and demonstrate what she Roles of CHN preaches in matters concerning health 1. Provide of Nursing Care 2. Health Monitor -Detecting deviations from health WHAT IS FUNCTION?  It is a set of activities and takes expected of a 3. Health Teacher - Health education is one of the person to perform by virtue of his position or most frequently used intervention by the nurse, role in society. and every contact with a client. 1. Initiates contact, establishes and maintains an 4. Counselor -Giving appropriate advice and effective working relationship with individual broadening a client’s clients/patients, families, specific population insight about a problem groups, other social units and organizations in the community 5. Client/Patient Advocate -The nurse protects the interest and welfare of the client/patient when the 2. Assesses and detects deviations from health latter’s health , safety or welfare is threatened by among individuals, families, specific groups others, and acts as their eyes, ears and voice and the community as a whole with the use of appropriate, valid and reliable methods and 6. Change Agent - Changing individual, family, tools. group or community behavior, including lifestyle and the environment, in order to promote and 3. Provides skilled nursing care to the sick and disabled patients requiring part-time 7. Community Organizer - The nurse stimulates professional nursing service in various settings and enhances the community’s participation in planning, organizing, implementing and evaluating 4. Administers prescribed medications, health programs and services, initiates community treatments or emergency care to the development activities to recognize and manage individual health and health-related problems. 5. Follows up complicated or problematic cases, 8. Team Member - Member of a health team and including communicable and works in close coordination with them to enhance noncommunicable chronic/long-term community health diseases/cases in the community, provides appropriate nursing care, health teachings and 9. Trainer, Supervisor and Management - The referral, as needed nurse assumes the role of a trainer and supervisor of lower-level health personnel such as the public 6. Provides health teachings/education to health midwife. The nurse acts as a manager or individual clients/patients, families and  specific population groups during every appropriate opportunity in various settings. 15. Participates actively in in community organization and development activities. 7. Provides guidance and counselling to individuals, families and groups with specific 16. Participates in communicable disease control health or health related problems. programs, including secondary prevention activities addressed to the susceptible or at- 8. Assesses the environment in the home, school, risk population groups in the community. workplaces and the community as a whole to identify risks and hazards to health; works with 17. Coordinates nursing services with those of other members of the health and intersectoral other members of the health team as well as teams to reduce, modify or eliminate the with the services rendered by other related hazards in order to prevent diseases or sectors and accidental injuries. 18. Non-government organizations involved in 9. Plans properly and conducts home visit follow- family and community health development. ups of high-risk or priority families in the community with the ultimate objective of 19. Evaluates health/nursing services provided to enhancing the families’ capabilities for self- individual clients/patients, families, specific care and to effectively cope with health and population groups and utilizes the results or health-related problems. findings to improve future services. 10. Initiates and/or participates actively in the 20. Keeps accurate and complete records and planning, organization and conduct of reports of nursing services and related screening/casefinding program for specific activities, and assists in the preparation and diseases, or in special health-promotive and maintenance of the health agency’s records preventive programs; provides appropriate and reports system, including vital statistical management and/or referral to cases found. data. 11. Provides health supervision to the school 21. Participates in the planning, implementation, population, identifies cases needing medical monitoring and evaluation of specific care and/or home follow-up, manages or programs of the health agency particularly refers cases, as needed. those with a significant nursing component such as MCH and Family Planning, 12. Provides health supervision to workers Communicable Disease Control, non exposed to certain health hazards and communicable diseases control, mental health institutes appropriate health-promotive and and health education programs. preventive measures as well as referrals, as needed. 22. Independently plans and conducts, or participates in epidemiological, nursing and 13. Provides rehabilitative nursing services to the related studies on community health. physically and/or mentally disabled/handicapped in the community. 23. Demonstrates a good example or role model of a healthful personal and family life to 14. Trains and supervises the work of auxiliaries individuals, families and the public at large. and indigenous health workers and volunteers, such as community health workers, traditional birth attendants and healers and health care volunteers.